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Podcast/Transcript on Fraudulent Sexually Transmitted Diseases (STDs)

(Run time 00:11:05 min.)

Moderator: Shelly BurgessMay 2, 20119:15 am CT

Shelly Burgess:

Good morning. Today we are here to talk about a recent Food and Drug Administration and Federal Trade Commission announcement to remove fraudulent STD products from the market. Joining me this morning is Dr. Jeffrey P. Engel, State Health Director for North Carolina Department of Health and Human Services. Good morning Dr. Engel, how are you?

Dr. Engel:

Good morning.

Shelly Burgess:

Dr. Engel if you could just please tell me a little bit about your background and your current role as the State Health Director there in North Carolina.

Dr. Engel:

Sure. My background is as an infectious disease physician in adult internal medicine so I have this clinical training, I’m board invoked in internal medicine and infectious diseases and for the early part of my career was in an academic practice but it was a community based medical school. We saw lots of patients.

In 2002 I came to work for the State Health Department as the state epidemiologist and now I am the State Health Director as of March 1, 2009 in charge of a variety of programs the Division of Public Health for the North Carolina Department of Health and Human Services.

Shelly Burgess:

How big of a problem are STDs in this country?

Dr. Engel:

STDs are a very important problem. You’re going to see them mainly in morbidity statistics, not in the mortality statistics. So it’s not going to have that kind of importance that heart disease, stroke, and cancer have in our nation’s health.

We’re primarily dealing with younger people who are sexually active and we’re dealing mainly with an acute illness that has a short incubation period for the most part. There are obviously certainly some sexually transmitted infections that are much more chronic in nature like HIV disease being more serious but hepatitis and others as well.

But in terms of the importance of a problem in the United States, it’s probably the most common outpatient problem for young people who are sexually active in the country.

Shelly Burgess:

Now I’ve seen the term STI or sexually transmitted infection used. Can you explain the difference between that and an STD?

Dr. Engel:

I think it’s really more of a labeling. STD is sexually transmitted disease, it’s the older term. Sexually transmitted infections came into parlance maybe 10 or 15 years ago and it’s more specific in that these are transmitted infectious diseases person-to-person spread and I think they’re more accurate in terms of some of the public health notifications. But I think they’re used interchangeably and synonymously.

Shelly Burgess:

Are STDs more prevalent amount any given ethnic group or perhaps in rural versus urban areas in the country?

Dr. Engel:

Well it depends on where in the country. I can speak certainly about North Carolina’s statistics, that certain STDs or STIs are more associated with minority groups, particularly African Americans. In North Carolina we have incident rates of Gonorrhea and Chlamydia that are 10 to 100 times higher in African Americans versus whites and in Hispanic population the same kind of disparity exists.

Rural versus urban, not a lot of difference there. And again these are mainly diseases in people between the ages of 15 and 44 but it doesn’t mean we don’t see it in older Americans as well.

Shelly Burgess:

Can you discuss the importance of appropriate diagnosis by health professionals given that most of the time STDs don’t have noticeable symptoms?

Dr. Engel:

First of all, some of the more common sexually transmitted infections definitely have noticeable symptoms. There is a brief incubation period that’s associated with sexual intercourse often unprotected and so whether it’s a male or female they’ll have certain genital symptoms that are obvious and abnormal and painful like painful urination and so on.

But you’re absolutely right. Many of these infections don’t - do not have symptoms and I think probably the biggest threat and more common one would be a Chlamydia infection with women, they can harbor this for many months to years and then they don’t know about it until they try to become pregnant and realize at that point in time that they have tubal scarring from an old Chlamydia infection that they never knew they had.

Another example of a long latency period of an asymptomatic sexually transmitted infection would be human papilloma virus. Again in women, they have had it for years and they don’t know it until they go for a pap smear and then they found out that they may have changes on their cervix or even early changes of cancer if not full blown invasive cancer of the cervix. So again there is an example of where you do not have acute symptoms but have definite long term very important clinical outcomes at the end.

So if you look at the more common ones, I would say Chlamydia and human papilloma virus which is genital warts. There are over 100 varieties of genital warts. And it is absolutely important that people get accurate diagnoses whenever they are concerned about their sexual behavior or in that practice or if they have symptoms, they should certainly get accurate diagnoses at a bona fide clinical provider.

Shelly Burgess:

Why don’t people get tested? Is it shame or fear?

Dr. Engel:

I think it’s a lot of that and they’re also concerned about confidentiality because they know that if they have a disease it’s going to be reported in the public health infrastructure, these are mandated rules, and what if their sexual partners are notified against their wishes. These are all things that concern people.

However, when the clinical consequences are so great as I just outlined, I would think that this would be less of a concern in terms of the risk versus the benefit of going and getting an accurate diagnosis and treatment to prevent long term complications.

I must say though since I’m now in public health, I can say that the public health record is held as much in confidence as your personal health record is. And we in North Carolina take a lot of precautions to make sure that confidentiality is not breached.

So in terms of that part of the fear equation and not getting treatment, I think health departments across the nation are very well versed in patient confidentiality and keeping those reports confidential.

Shelly Burgess:

What treatment options are available for people if they have an STD?

Dr. Engel:

Well I think the more common ones like Chlamydia and gonorrhea there is an - there are antibiotics and the good news is that they are curative in over 90% of cases and they are easy to take, often with just one dose. So what happens is that you get evaluated, diagnosed, and treated all on one visit. So for many of the common sexually transmitted infections it is really very straight forward in terms of diagnosis and treatment in kind of a one stop shop if you will.

So that’s the good news. Some sexually transmitted infections require more involved treatment like Syphilis for example. It may require two or three treatments with penicillin or a longer course of therapy if you have a penicillin allergy but that would be an example where it may not be a one stop shop.

Shelly Burgess:

Okay. What role can parents play in educating their children about STDs?

Dr. Engel:

I think particularly with young people who are still living with their parents these are usually we associate this with someone who is 18 years or younger. Parents can have a major role particularly when children get into that adolescent phase and begin to have that part of their growth that spells sexual development. And it might be at the sign of menarche in a young girl or, you know, developing those sexual - secondary sexual characteristics of puberty and adolescence.

These are hard conversations for parents to have with kids. I mean, I have three children myself and I know it wasn’t easy for my wife or myself. But these are things that parents must do. It’s really about safety and making sure that they grow up into healthy adults and have normal sexual development along the way.

Shelly Burgess:

In closing Dr. Engel, is there anything that I haven’t asked you that you feel is important for listeners to know about?

Dr. Engel:

Yes I think we talked about earlier that sexually transmitted diseases can have symptoms early on and we talk about those that have genital symptoms like discharge or painful urination, sores, or cankers in the genital area or wherever there was sexual contact.

But there are many sexually transmitted infections that you may not know that you’ve caught from a sex act and I think the most serious one is HIV disease. And this is one that can be incubating in the body for 30 days or longer.

The early symptoms might be missed because they could be mistaken for a cold or a flu because it may just present with fever and feeling bad and tired for a few days and then go away and that flulike illness actually may have been the early onset of HIV disease. So these are some of the other precautions that I think are important for people to know.

Shelly Burgess:

Well I would like to thank you for your time this morning and with that we would like to close out this podcast. Thank you very much Dr. Engel.